KINGMAN - Registered nurses from throughout the state flocked to Phoenix Tuesday morning to join Arizona Representative Phil Lopes (D-27) in announcing a sweeping bill designed to increase patient safety across the state by requiring hospitals to abide by mandated RN-to-patient ratios on all units at all times, as well as provide for whistle-blower and advocacy protections for RNs.
The act reflects three years of organizing and advocacy by Arizona's new RN union, the National Nurses Organizing Committee - Arizona, part of a larger nationwide organization with more than 85,000 members in all 50 states.
Liz Jacobs is a communications specialist with the California Nurses Organization and an RN with the national NNOC. She said a similar bill was being introduced in Texas the same day, and other bills were also being scheduled for introduction in Illinois, Pennsylvania, Nevada and Ohio later this year.
Jacobs' home state is thus far the only one in the US to pass mandated RN-patient ratios, in 1999. Jacobs said the only other place in the world with mandated RN-to-patient ratios is the Australian province of Victoria.
"All the data has pointed to the fact that if you create a safe place for nurses to work in, the nurses will return to the hospitals and stay," she said.
"In California we've had 100,000 additional RNs since the bill was signed in 1999, and the vacancy rates have been hovering around 5 percent when it's closer to 15 percent nationwide."
Jacobs said the bill, if passed, would drastically reduce the number of patients under each nurse's care, allowing them to give more attention to the patients who need it most.
She said the added emphasis on individual attention could go a long way toward preventing the most easily-preventable post-surgery diseases.
"We have found that the most important thing in all of this is that better RN staffing improves patient outcomes," she said. "There're over 60 studies ... that very specifically point to better outcomes, and that's critical, and it's also a cost savings."
Based on her discussions with nurses nationwide, Jacobs said by far the most difficult unit to work in is a medical/surgical unit, where most patients end up before they are discharged from the hospital. She said it's not uncommon for a single nurse to attend to anywhere from eight to 12 patients at a time in such units.
"Ten to 15 years ago, you would have a patient who was in the (intensive care unit), might stay there for several days and wouldn't be rushed off to a medical/surgical floor - ICU's are the one place in Arizona where the law restricts the number of patients nurses are given," Jacobs said.
"What's happening is, these patients are being pushed out of the ICU faster and pushed onto medical/surgical floors where nurses already have eight or nine patients."
The result, she said, was stressed-out nurses spreading so much of their time between patients that it becomes easier to make mistakes, overlook conditions or simply fail to devote the requisite time to a patient's well-being. Under the Hospital Patient Protection Act, however, such situations could be avoided by limiting the ratio on medical/surgical floors to just four or five patients per RN.
"One of the most important things after surgery is to make sure a patient gets up and walks to improve circulation," Jacobs said.
"Blood clots and pneumonia are some of the biggest preventable side effects of not properly covering someone days after surgery. There's a direct correlation between improved patient outcomes and better staffing, and that's a cost savings."
Jacobs said that according to this month's edition of the Medical Care Journal, an additional 133,000 RNs in the nation's hospitals would save approximately $1.6 billion in annual patient care costs, plus another $240 million in increased productivity from more rapidly-recovered patients.
"If you combine the medical savings with the increased productivity, the partial estimates of economic value is $57,700 for each of those additional 133,000 RNs," she said. "There've been no hospital closures (in California) because of the ratios. We've got a living example, so it's not hypothetical."
Maybe not, but the chief executive officer of Kingman Regional Medical Center, Brian Turney, is not so fast to sign on to mandatory ratios. In a statement released Tuesday morning, Turney said ratios are only one of a number of factors involved in patient care, and it's not even the most important.
"Using ratios as one tool to determine staffing needs is certainly appropriate, but mandated fixed ratios are not good for determining individual patient needs," Turney said.
"Many factors can affect nurse-patient staffing such as the acuity of the patient, support staff available to assist the nurse, nurse's experience, and the unit design. It is a mistake to ignore these other factors."
Turney added that both the Arizona Nurses Association and the Arizona Hospital and Healthcare Association support staffing based on patient acuity rather than ratios.
Jacobs believes the support is there from nurses on both sides of the political spectrum. She noted that it took numerous attempts to pass California's legislation, and even then the NNOC had to take on a years-long challenge from Gov. Arnold Schwarzenegger's office before securing the new ratios. But nurses, Jacobs said, are a resilient bunch, and she was confident that the legislation would pass - if not now, then eventually.
"Yes, we have obstacles, but you'll find that nurses, when it comes to patient safety, are fearless, and they won't stop until they have a safe environment for their patients," she said.
"And if they can't, they'll find an environment where they can."